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Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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436<br />

K.W. Kercher<br />

Physical Examination<br />

Well-developed male. 5′10″ 246 lbs BMI: 35.<br />

Abdomen: s<strong>of</strong>t, non-tender. No masses.<br />

Focused inguinal examination : Moderate tenderness to palpation at<br />

the pubic symphysis, extending laterally along the pubic tubercles to<br />

both sides <strong>of</strong> midline. Focal tenderness to palpation over the external<br />

rings and inguinal canals. No palpable hernia defect on either side.<br />

Increased discomfort with resisted sit-up. Internal and external hip rotation<br />

negative for pain. Mild pain with adduction <strong>of</strong> the hips against<br />

resistance.<br />

Imaging<br />

Magnetic resonance imaging (MRI) pelvis: Bilateral rectus abdominis<br />

and adductor longus aponeurosis pubic osteotendinous junction<br />

avulsion injuries (Figs. 34.1 , 34.2 , 34.3 , and 34.4 ). MRI findings <strong>of</strong> a<br />

“secondary cleft” are visible on fluid- sensitive sequences as a curvilinear<br />

fluid-signal interface that is continuous with the symphysis pubis<br />

and undermines the inserting structures at the pubis.<br />

Fig. 34.1. Right adductor tear with secondary cleft sign (fluid in pubic symphysis).

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